Intubation
Personnel
If urgent intubation and consultant is off-site, call the anaesthetic registrar on bleep 6000 for immediate assistance.
In extreme emrgencies, if the bleep 6000 anaesthetist is unavailble, call the Adult ITU to request immediate assistance.
Two doctors minimum
Kit
Intubation trolley
END-TIDAL CO2 MONITORING IS MANDATORY
Laryngoscopes: > 18 months curved adult MacIntosh 3. <18 months, straight flat blade such as a Seward or Robertshaw or Cardiff blade can be used from birth to adolescence
Tracheal tubes ( The formulas given below are only an estimate and are not a substitute for direct visualization of the tube position at the cords or tube placement on CXR)
Cuffed tubes acceptable for all ages, but cuff pressure must be < 20cm H2O - usually only available for > 4.5mm tubes
Gum elastic bougie
Yankeur suction
Laryngeal mask available
Drugs
Have the following drugs drawn up unless instructed otherwise
Anaesthetic drugs
Propofol 0.1 - 0.2ml/kg
Fentanyl 5mcg/kg IV
Midazolam 0.1mg/kg
Thiopentone 6mg/kg
NMJ blocker
Vecuronium 0.2mg/kg
Gas induction
This may be required for cases with a difficult airway - only set up the machine if you are an anaesthetist.
Notes
Post-intubation CXR mandatoryOnly cut the tube after CXR has confirmed position. Do not cut too short in patients who might become oedematous - this will cause the tube to migrate proximally
If the tube needs to be advanced or withdrawn, use sedation and consider paralysis
ETT size Guide
ETT diameter
|
ETT length at lips
|
ETT length at nose
|
Laryngeal mask size guide
|
Patient weight (kg) |
Inflation volume (ml. Of air) |
1 |
<5 |
2-5 |
1.5 |
5-10 |
3-8 |
2 |
10-20 |
5-10 |
2.5 |
20-30 |
10-15 |
3 |
30-50 |
15-20 |
4 |
50-70 |
20-30 |